Q&A with David Rice

Has there ever been a workforce reduction at HRMC in the past 15 years, and does this workforce reduction indicate any long-term financial problems?

This re-engineering process is similar to 1993 when I first arrived. In 1993 there were different issues and work force reduction was not a necessary strategy. The changes we are now making are responding to the changing indicators of the current healthcare system.

The re-engineering process we are going through is the solution to avoid any possible long-term financial problems. Projected revenues were not realized which called for an adjustment in expenses. This was an opportunity to re-engineer the organization to achieve a higher level of operating efficiency.

What is total number of employees at HRMC? (total and full-time equivalencies)

734 FTE’s and 205 part timers, a total of 939 employees.

Has the hospital experienced a net loss in recent months?

The total excess margin fiscal year to date April was 5.18, May was 4.70, June 3.61. The monthly margins for the month of April was -2.19 and June -5.09. In view of the two months losses and the trend of decreasing margins, it was clear that changes needed to be made.

What departments were the workforce reductions in?

Re-engineering occurred in every department including nursing where a number of supervisory positions were transferred to bedside patient care. No bedside nursing positions were reduced. In fact bed side care coverage was increased.

How much of the reduction was achieved through attrition/retirement, how much was through layoffs, how much was through transferring to other departments?

There were 5 administrative positions that we were not able to place through attrition/retirement or transfers to other departments. These personnel will be given first option as the demand for new positions occur.

The press release said the workforce reduction of 36 positions resulted in only five layoffs. How significant are the savings if only five people were actually laid off?

The savings were not measured based on five employees. Savings occurred through attrition and merging positions within departments. The merging process is referred to as a re-engineering of the organization to achieve a higher level of productivity, increasing efficiency, and producing a higher level of quality. It is believed this strategy, which is used by other hospitals and industries will save approximately $ 1.6.million over a twelve month period.

Was there not enough work to go around for the existing staff, or, do these layoffs mean some departments are short-staffed?

Most of these changes were recommended by HRMC Directors. Our mutual understanding was that no changes would be made that would affect quality care. Their successful efforts to share functions and cross over departmental lines made the re-engineering process work very well.

Is the reduction connected to the overall nurse restructuring?

Ms Harris began the process in nursing shortly after her arrival in February. Administration had begun considering changes needed to enhance the delivery of patient care and services prior to her arrival. I conducted a national search to assure the highest level of expertise would be employed to produce an improved level of patient care.

At the surgery center public hearing, we heard about staff taking a mandatory day off to help save on payroll. Was this administration only or other employees as well? Did this not do the trick to save money?

A mandatory day off without pay was requested of our Department Directors. I also requested two days off without pay for HRMC Administrators including myself. Re-engineering involved a serious commitment to achieving efficiencies which should result in cost reductions. The example starts with leadership.

Is this an odd time for a downturn in patient census, during the summer months when second-home owners are in town and the population in the community is up?

We have discussed this with our medical staff leadership only to learn that volumes tend to be down across the board. Medical staff leadership has not been able to find a negative reason.

Is the lack of orthopedic services, namely no on-call orthopedists, one reason for lackluster patient census?

We have half of the on-call covered. However, covering only half call has an impact. Based on the progress we have made in our recent recruitment efforts we are encouraged that a resolve may be in the making by the end of this year.

Has the ER transition contributed to census being down?

Emergency visits this year- to- date are up by 4%.

How will the new surgery center potentially bring up patient volume and/or revenue, and does this cash-flow issue jeopardize the $16.5 million center?

Our current surgery system, although a safe one, is inefficient and cost ineffective for the hospital, the surgeons, and the patients. Demographics show HRMC has significant growth potential in surgical services that cannot be met in our current facility. Our success in delivering an efficient and cost effective surgery program is required in order to grow the organization. The surgery center, including space for additional services remains on schedule. Its successful completion is critical to sustaining a quality hospital for this community.

Will the layoff affect public support for the surgery center?

Re-engineering the organization to be accountable to the public for a well run organization, I should think is what the public expects and will support.